In an era of deep uncertainty and worry for many, seniors are increasingly embracing design principles focused on the safety and security of home.
It’s not a new concept, with some wondering if the “homelike” movement has gone overboard or become overwrought. With noted exceptions, the answer, by and large, is no. If anything, experts say long-term care’s concept of home has become more expansive and inclusive.
Some, like Melinda Avila-Torio, associate managing interior designer for THW Inc., Atlanta, believe the sheer diversity among senior living residents makes it difficult to move people in a singular design direction.
“It’s difficult to say because ‘homelike’ means different things to many groups,” she says. “This can be different in socioeconomic, cultural, regional and vocation.”
Her colleague, Senior Design Architect Dustin Warmus, believes it’s sometimes not good to mess with what some residents see as perfection.
“The only time I would be concerned about taking the homelike theme too far is when the spaces do not take into consideration the needs of the senior residents living there, such as the furnishings not meeting the specific seat height, depth and firmness that we typically provide,” Warmus says. “That old comfortable recliner could be a real problem getting in and out of.”
More than pretty buildings
In 2014, John Knox Village in Kansas City, MO, was hunkering down after weathering the housing and economic slump of 2007-2009. Like so many in long-term care, occupancy levels were stalling and portions of the village were looking dated and out of step with the market, as Vice President of Senior Living Maria Timberlake recalls. Surveilling the landscape, it was readily apparent that just a fresh coat of paint would accomplish little.
A bold plan was needed. One that reflected an infectious yearning among current and incoming clientele to be part of something bigger and vibrant.
In late April, Timberlake and staff unveiled their massive plan to the hundreds of residents and workers “on how we were going to redefine the living experience,” she recalls. “That meant not only major capital investment but a culture change toward more hospitality and a service excellence focus to meet the changing expectations of the people we serve.”
It was invigorating and rejuvenating.
A competitor’s grand opening a few years before showcased a spectacular community festooned with fine art, chandeliers and exquisite furnishings. Timberlake knew immediately what not to emulate. “I knew right away that, for the clients we’d been serving for decades here, pretty buildings alone weren’t going to cut it,” she says. She instructed the designers at Austin, TX-based StudioSix5 that John Knox’s new “neighborhood,” The Meadows, was not going to be a “frou-frou,” or fancy, community.
“When you elevate, you sometimes think you want to make it fancier,” she says. “Not us.” The Meadows had all the niceties like stone countertops, but furnishings alone weren’t going to define it.
Entire apartment buildings were either gutted or torn down. It looked more like a resort than anything that had come before. Seven restaurants — no longer called “dining halls” — each with its own special cuisine, staff and theme, as well as bars and pubs, dot the new independent living campus. Nearly every week, the city manager of Lee Summit eats lunch there.
One day, months after the project was completed, an elderly resident approached Timberlake. He and his wife had entered The Meadows fairly healthy months before but had since experienced serious issues.
“He looked at me and said, ‘You know Maria, when we moved here, it was so important to us to pick out just the right kind of granite and secure the best view, but now that we live here, the sense of community here is what really mattered and we didn’t even know it at the time.’”
At the same time, some in the industry say the term “homelike” has become ambiguous. Like other buzz words, there’s a fear it’s being overused to the point of becoming meaningless.
“The term ‘homelike’ reminds me of processed cheese food product, which is only about 10 percent real cheese,” says Margaret Calkins, Ph.D., board chairwoman of the IDEAS Institute, which provides solutions that improve the lives of older adults through rigorous applied research.
“Some of the ‘homelike’ environments are also only about 10 percent real. I can work to help a care community create a setting where a person can feel ‘at home,’ but the organizational/operational aspects of the environment also have to support this approach.”
And while minions of incoming residents covet the hotel and hospitality look and feel in their soon-to-be senior living digs, no one is giving last rites to the comfort-food dining and homelike ambience that continues to characterize so much of today’s senior living inventory.
“It is so important to have visual cues and the ambiance of home as skilled nursing built environments are so critical to the quality of life,” observes Avila-Torio. “It is still important for the adult children to know that the visual cues of home will provide a smooth transition into the next level of care.”
Nowhere is that more evident than in memory care, where connections to the comforts of home are a critical component of therapy, according to Jacki Zumsteg, director of interior design for Invacare Interior Design.
While assisted living and independent living communities are gravitating toward more hospitality features, many are finding residents still bring those mementos from home to create that “safe space” in their private rooms, says David Sullivan, business manager at Flexsteel Healthcare.
While many small or rural communities still lean heavily toward homelike ambience, it’s common to see demand for “stunning new hospitality themes” in urban areas, says Jim McLain, general manager for the Eldercare Interiors division of Construction Specialties, Inc.
“Aesthetic choices for materials and finishes must be supported by high-quality selections that will not compromise safety, performance and durability for the long term,” he adds.
As tempting as it might seem to the untrained eye, most design experts and vendors believe owner-operators have shown remarkable and mostly tasteful restraint. Says Jamie Thorn, national sales manager for Forbo Flooring, “it’s all about allowing the resident to be comfortable. What do your focus groups or consumer surveys tell you?”
Perspective is everything
“No matter how attractive the design may be, for many seniors it will never replace the home they left behind where they raised their children and grandchildren and celebrated countless birthdays and holidays,” says McLain. “There is no place like home, and today’s designers and owners are sensitive to this as they seek to create an attractive and welcoming design that will bring comfort, peace and a sense of belonging to the resident regardless of their commitment to a design theme.”
The lure of city life
New York’s New Jewish Homes’ communities are a perfect example of how embedded and successful the hospitality and hotel trends are. Recently, the organization opened a luxurious new short-term rehab facility and suite with beautiful contemporary design and some spa-like amenities.
“It’s more like the home you want to live in as compared to the one you remember,” quips James Dale, director of marketing and communications.
While the comfort and familiarity of home always holds a special place in the hearts of most seniors, they are looking for their new home to be just that — new.
“Most of our residents want to have mementos from home in their rooms. But the reality is they generally don’t want to bring much of anything else they consider ‘old,’” says Sandra Mundy, administrator of the Sarah Neuman in Westchester, a New Jewish Home community. “They want high-end, new furniture. They want something fresh and new.”
An avid proponent of the “small house” concept closely modeled after the Greenhouse project, Sarah Neuman is building a cluster of the facilities on its campus, each with a dining and commons hub with 13 apartments lining the outer rings.
It’s all a reflection of what makes today’s seniors different from their predecessors.
“The generation upon us now is more sophisticated. They travel more. They eat out more,” Mundy says. “My grandparents didn’t travel or go out to eat. The new ones coming on board don’t even want to think this is going to be their last home. Even if they know they’re not in a hotel, they want to feel like they are.”
In its most radical departure from the homey “small house,” Sarah Neuman’s latest completion hosts a commons that conjures the seating areas of places like the Plaza Hotel and Ritz Carlton. Couches are nowhere to be seen.
“We are seeing more and more benches, wingbacks and other lounge chairs and occasional tables designed in the mid-century modern style,” says Michael Zusman, CEO of Kwalu. “In new builds and remodels, the trend is toward stylish spaces filled with seating and occasional tables that promote conversation and light dining — all designed to support an active lifestyle.”
Of course, some of the hospitality focus in senior living stems from the fact that more and more seniors are being discharged from hospitals earlier now into short-term, post-acute care, observes Calkins.
“Short-stay residents don’t want to be told this is ‘home’ because their goal is to do the rehab necessary to get out and go back to their home,” she says. “That doesn’t mean the spaces need to feel clinical and institutional.”
Gone are features like swags, heavy drapes and traditional styled designs, “which are being replaced with cleaner, fresher, more modern and transitional designs,” notes Sara Gregory, project manager for THW Design, Atlanta. “Variety and activity are the big takeaways now, as are media spaces, digital communication, multiple dining venues, outdoor amenities, variety in size and quantity of gathering spaces, and lots of wellness options.”
Designers such as StudioSix5 are convinced the hotel and hospitality movement is here to stay.
“People keep on saying they want this residential feel, but I just think that’s going away,” says Dean Maddalena, president and architect. “It may work in the small neighborhood or rural environment, but I don’t see that brought up as much anymore. It all comes down to familiarity. That’s the best thing about it. Someone in New York is going to want an environment that gives them that continuity.”
The ‘experiential’ movement
As noted, many senior living architects and designers today are taking on broader considerations than ever before, beyond just the physical spaces where people bathe, eat and sleep.
Timberlake calls it “the relational experience. The sense of community and belonging that trumps everything else. When you’re planning a building and dealing with square feet and materials, everything is very intentional about the decisions you make,” she says.
Greg Smith, chairman and CEO of Maplewood Senior Living in Westport, CT, calls it “experiential. This is a fundamental shift,” says Smith, who also is a successful real estate investor in the hospitality, residential and office sectors.
“We’re focused on delivering to residents and their families a unique experience that’s not just homelike, but delivering all services and amenities in these buildings where we are now in the midst of our fifth or sixth iterations,” Smith says. “The fundamental shift is not only the result of thought leaders but the expectations of the residents and, probably more so, their families.”
It’s also important for providers to remember the concept of “home” can include activities such as driving.
Marquis Health Services announced it had completed the $2.5 million renovation of Coral Harbor Rehabilitation and Healthcare Center in Neptune City, NJ, in June. Among its new features are an overhaul of the long-term care floor and a therapy gym with state-of-the-art equipment. This includes a smart car to help patients simulate daily living skills during the rehabilitation process.
From the July 01, 2018 Issue of McKnight's Long-Term Care News
